Dr. TO 874

March madness injuries Jamal Shead from Houston,  Flag thrown everywhere for coffee talk,  Jaden Daniels top 3 draft pick, Answering text from listeners, & finally carpal tunnel teaching moment . Todays Moments from the show 

Episode Transcript

(00:00):
It's tip off time for Doctor tO. Sorrel and Inside Sports Medicine on
ninety seven to one. The FreakDoctor Sorriel, one of the nation's leading
orthopedic exertions and former head team physicianfor the Dallas Mavericks, bringing his unique
sports insights and stories from inside thegame. With special guests from the world
of professional, college and high schoolsports and sports medicine, the Doctor breaks

(00:20):
it all down. Buckle up yourchin strap and tighting your laces for the
most informative ninety minutes in sports medicine. It's kickoff time for Inside Sports Medicine
with Doctor t O. Soryal onninety seven to one. A freak zack
outside game. No I'm talking about. Just let them know ACU long ago

(00:49):
to the oh Ray. We gota lot of nice scires. Good Saturday
morning, everyone, and welcome toInside Sports Medicine. That awake yep,

(01:15):
I'm your host, Doctor t O. Sorryal. Welcome to live episode eight
hundred and seventy four, not allof them on this station. This is
your Sports Medicine current events show,where the topics are ripped right off of
the sports desk. Over the nextninety minutes, you'll have an opportunity to

(01:37):
call in text in. I thinkI mixed that up. Over the next
ninety minutes, you're gonna how doesthat go again? Anyway, welcome to
the show. It's ripped right offthe sports desk. I already did that.
I already did that. Hopefully you'regoing to be entertained. I don't
know. I learned something and learnsomething over the ninety minutes. Sorry,

(02:02):
I'll hear doctor Ballard across from me, Doctor Blumenthal to my right, Doctor
Blaylock to my left, either wayaround, and Garrett's on the other side
of the glass. Hunter and Danielare also in the studio. We have
a full house this morning, andwe have a lot to talk about.

(02:22):
So yeah, so we're all practicing, so we all see patients during the
week and we take notes and wetalk about some of the interesting topics on
Saturday morning. This is intended tobe a call in show, but since
we've gone to ninety minutes, sometimeswe don't have the opportunity to take the

(02:46):
calls. But I'm gonna try tomake an exception today. If you've got
a good question that you would likeanswered, two one, four, seven,
eight seven, nineteen seventy one.I'm gonna say that number five or
six more times two, one,four, seven, eight seven, nineteen
seventy one. It's also a textnumber, so if you're uncomfortable about being

(03:07):
on the air, you can justtext in your questions and we're going to
get to it. Never mind,Okay, it's going to be another thing
that I would have regretted saying.So I did something, another thing that
I would have read thinking of lists, you've got to listen to the things
that you just you had another barelycrossing the line. So I did something

(03:31):
fun yesterday that I have never donebefore. I went to the NCAA basketball
Sweet sixteen event Jealous the American AirlinesCenter. I saw the first game,
which was why are you throwing aflag this early in the in the show?

(03:53):
Because you have forgotten that about twentythirty years ago, you and I
went. We were or young pups, probably in our thirties, and we
went to the old reunion to aSweet sixteen? Are you kidding me?
Yeah? And I remember one ofthe teams was I was I there?
Yeah? You and I went andwe were either young pup doctors or residents

(04:15):
or whatever, and we remember wesee I remember we saw Arkansas. I
think you're making this up. Iremember one of their players, a big
guy, Oliver Miller. Yeah,oh yea. That was the team we
saw play. And we just wentto reunion on a lark. Got some
tickets, probably scalped them for twentybucks or something back then because it wasn't
as potfooter as it is now.So I did something that I've done before.

(04:39):
Apparently I didn't remember that. Idid not remember. So the first
game was Marquette against NC State Stateand that was fun, even though I
went to high school in Wisconsin andI was rooting for Marquette. I they
did not play like a number twoseed yesterday. No. And the second

(05:00):
game Duke against you of h worththe price of very entertaining. I will
say that there were several sports medicineangles that I do want to bring up
today. Who won that game?Duke one? Duke one? So Houston
very athletic, very intimidating, verybig. Are they number one ranked overall?

(05:26):
Yeah? So that's another number onethat went down. So the Houston's
out, Yukon's in produced still in, and so two ones are still in.
So I mean several things from thatwonderful event that I really enjoyed,
even though it was a late nightand you have to get up at four
in the morning to come do thisshow. So their number one player goes

(05:49):
down with an ankle injury, doesnot come back, does not come back.
And it wasn't until early this morningwhen I was watching Sports Center I
got to see the replay and itseemed relatively minor. Yeah, I mean
the angle of trauma. You wereat the game. I was not at

(06:10):
the game, and I was thinkingabout texting you because we were texting before
that game started, and after hesprained his ankle, I was actually expecting
him to come back. I meanafter seeing the replay now, mind you,
Yes, it looked kind of ohman, But we've seen some nasty
sprains I've seen with the lateral aspectof the ankle, like hits the ground.
I've seen ninety degree urns. AndI thought that we talk about risk

(06:35):
versus reward. I thought they werereally gonna tape up, tape him up,
and do whatever they could to tryand at least see if he could
go. But so at the game, there's no replay, so I had
no idea how bad it was.And judging by the fact that he was
rolling on the ground and he wascarried off and whatever, I thought.

(06:57):
I thought he might have broken it, okay, right, and then he
was back to second half in aboot on a scooter and I thought,
Wow, this must really be bad. And I see the replay this morning
and I'm thinking, who's their doc. Yeah, it looks like a spring
tape it up and play. Yeah. Yeah. I mean I don't know.
I don't know the full story,but it didn't look as bad as
what we've seen. And I know, I mean because even my daughter was

(07:18):
watching. She was like, ooh, that looks bad. And I was
thinking, I mean, it's fad, you know, I get it.
But for inst of all, itwas non contact, right, I mean
so, and when I say noncontact, he didn't land on another player's
foot in his foot goes ninety degrees. Those are the bad ones. Yeah,
yeah, yeah yeah. And Iwas thinking, So the guy next
to me was asking, do youthink he's gonna come back? I said,
I don't know. I suspect hewas oh no, no, no,

(07:40):
no no. So the guy nextto me was saying, boy,
he's really wearing low tops. Thoseare the lowest shoes I've seen. And
I said, well, I hopethere's tape under there. Yeah. Yeah.
So this opened up a huge conversationfor this show. Why didn't he
come back? What is the lowtops versus high tops? Does that protect
you? And should should these guysbe taped or not taped? And one

(08:03):
of the other things that was broughtup, why didn't they shoot them up?
Well, where are you gonna putit? Yeah, ankle sprain is
not gonna be the deal. ButI will say this, because the low
top versus the high top, likeit seemed like everybody plays in low tops
now. But there's got to bescience on that, So there's got to
be an answer. Doesn't it makea difference. I'm guessing it's no.

(08:24):
There was a study and the answeris no. Okay. But and the
whole reason high tops were invented.Remember the canvas yeah, yeah, sucks
man cons yeah, yeah, converse, converse converse cons or was it kids?
Is it kids or whatever? Sohigh tops were invented to do just

(08:45):
that so you don't have to work. But they were canvas. Yeah,
and then when high tops went toleather, it doesn't hold your ankle as
well. Looks cool, doesn't holdyour ankle as well. So the latest
study that which is about maybe tenfifteen years old, low tops and high
tops don't really matter in terms ofankle sprains, but tape does. I

(09:05):
will tell you, per your instructionsand from some good high school trainers,
taping kept my kid from hurting hishand because he's going into the basketball season
with two spray ankles and he gothe didn't miss a minute because of good
taping. Yeah, so we madethe MAVs tape. We just it was

(09:26):
required and a lot of the guysdid not like the way that felt,
and so they would get a reallylight tape job. Look, if you're
if you're duking it out under thebasket and you land on someone else's foot,
tape's not going to protect you,but it will keep it from being
a third degree spring. You know, you'll still get a first degree,
you might even get a second degree, but you're not going to completely go

(09:48):
ninety degrees to the left. Well, you're going to have to explain what
is the audience the degrees you haveto go over that again? Mild,
moderate, severe? That was Thatwas That was episode one. So everything
we have in the world of sportsmedicine is mild, moderate, severe,
grade one, grade two, gradethree. That's it. But there's there's
more objective adjectivity than that. It'sjust that's how we explained it. But

(10:11):
I'm shocked that he didn't come back, and I'm scratching my head. Well,
and what's interesting is, you know, I mean they lost by three.
If he if he goes back outthere and plays they went again,
does that make the difference they went? That's the thing about it. And
so I was thinking, like evena sixty shy sheet, but I can't
remember it. That's it. Shit, the a sixty percent him on the

(10:33):
court to at least have some levelof influence on the game. Yep,
may have made the difference in threepoints considering how bad Houston shot and had
zero offense. Being ran, Ithought they could have used him. But
well, that means interesting enough,And I think that's one of the you
know, origins of this show isthat how the influence of injuries on the

(10:58):
outcome of athletics. I think ofit. You lose one in the NBA,
you lose one starter who gives youtwenty and ten to night difference between
getting out in the first round ofthe playoffs and getting a deep run.
You lose a quarterback in football,difference between being having a chance to win
right or get to the super Bowland having zero chance. Injuries are I

(11:22):
mean, that's why this is sointeresting. I mean, what if they're
able to get him back. That'sthe other question is what if they're able
to get him back? Not justthe injuries, but like how the injuries
are managed is just as important.Remember the Willis Reid thing. Oh yeah,
yeah, so will I think itwas a hammy. So he was
battling a hamstring injury, Willis Reidand this this is way this before my

(11:43):
time. Actually, and he comesback and he's hobbling on the court,
and I don't know if they wantor lost that game. I have no
idea if the Knicks won or lostthat game, but the fact that he
came out was such a boost forthe team. Kirk Gibson, hold on,
yeah, the same thing. Sohere's the other thing. You know.
There's an X ray machine in theA A Center. Oh yeah,

(12:05):
they mentioned it. They mentioned this. It's got an X ray. They
x rayed his ankle. They didsay they tried to retape him too.
Yeah, maybe he just felt likehe couldn't go. I mean, and
if he feels like he can't go, then that's the ultimate. If the
player tells you I can't go yet, that's it. Yeah, you can't
make him go if he's doing theteam more right. So here's in Scott.

(12:26):
You brought up so many good pointsin the last thirty five seconds.
Having that key player on the courtis so important. And I read something
on the ticker last night that Ifound that a little bit mind boggling.
So, as you guys know,I'm a big Notre Dame fan. My

(12:48):
kids went there, and Notre Damewomen's basketball has always been a kind of
a big deal, especially lately.Especially lately. Well, they ended up
losing last night in the women's NCAASweet sixteen or whatever, and the ticker
said that like their leading scorer waskicked off the court for like four and

(13:13):
a half minutes because the referees madeher take her nose ring out and so
she was not available during the keystretch of the game because she had a
nose ring. And I don't knowall the details. I'm just going by
the ticker. Okay, number one, somebody should have known the rules.

(13:33):
Somebody on that team should have knownthe rules. Number two, why didn't
you do it before the game.Why didn't the referee say, oh,
you can't play like that because theydo it in football. Yeah. Why
does it take four and a halfminutes to take a nose ring out?
I don't know. That's the otherquestion. There are many unanswered. There's
a lot of mysteries surrounding this fourand a half minutes. But this made
the ticker on ESPN because they kindof pointed the finger as that that's why

(13:58):
they lost, is that somebody wasout. So which goes back to I
think I need to tell that JackHenry story. I'll take. So there's
silence here, Jack Henry, what'sthe story? Jack Henry was the team
doctor for the San Antonio Spurs andplayoff game again way before my time.

(14:22):
Playoff game against the Lakers. Oneof the Lakers gets an elbow to the
I has a laceration, goes intothe locker room and Jack Henry, the
Spurs doctor, is responsible for sewingup the laceration on the lakers number one
player and he drags his feet andhe keeps him in the locker In an

(14:43):
ultimate gamesmanship, he keeps their numberone scorer in the locker room for an
hour and a half to sew upa laceration. Well, Lakers lose.
They they complain to the league.The league says, all right, from
now on for playoff, the visitingteam has to bring their own doctor so
this never happens again. That's aJack Henry story which brings us back to

(15:07):
sports medicine. One of the thingsthat we are all obligated to do is
to allow the players to showcase theirtalents. That is why we do what
we do. So if the nosering needs to come out, it can't
take four and a half minutes.If the player has an injury that is

(15:30):
protectable, protectable as sprained ankle,yeah, I can protect you. I'll
put you in some tape or braceor whatever. Then we give them the
opportunity to showcase their talents. Andlast night, two games with significant implications
both were impacted by the fact thatthe players could not be out there.

(15:54):
Yeah. So that's why we've beenon air for twenty three years because we
talk about this kind of stuff.Uh, it's break time, isn't it.
Oh No, I was trying tofind the highlight, but it's kind
of hard to find it whenever theydon't want to put it on yeah YouTube
or anything, so I try tofind I know exactly where it happened.

(16:14):
Happened with six twenty eight left inthe first period, so I was trying
to find the video of him rollingit. Yeah it was. It really
didn't even roll. It really didn'teven roll, all right. So one
of the other silly things that happenedin the game yesterday, another person sitting
close by and he was talking aboutthis, and I want to kind of
get the panels thoughts. He wastalking about how Houston looks so intimidating.

(16:41):
I found it. Okay, wellthat's all right, Well the listeners can't
watch it. He said, Houstoncan probably beat the Detroit Pistons or something,
whoever the worst team is in theNBA. Yeah, And I was
shaking my head. I don't knowof any sport where the college team can
beat the pro team. Yeah,your college team could beat the worst pro

(17:03):
team. I just don't. It'sbigger, faster, stronger. Yeah.
Well, and the level of skill, I mean, when you get particularly
in basketball, you get to theNBA level man. I mean an open
jumper is a layup. I meanit's for just about everybody in the league.
An open jumper is a layup.Whereas when you look at you of
aased last night, an open jumperwas struggle or to come come, you

(17:27):
know what I'm saying. So thedays when Alabama college football was just so
dominant, the LSU team that justkind of ran through the playoffs, you
still can't beat an NFL team.You can't. They're just different. You
don't have the horses. What aboutit. I think someone could have beat
the Caroline Panthers this year. Idon't think. No, No, I

(17:51):
know you're being funny, but Scott, what about individual Well, individual sports
are different. Individual, Yeah,you can get a phenom tennis player,
Yeah, that can beat a proble. I'm thinking like a Tiger Woods freshmen
stamp. Yeah exactly. Yeah.Okay, individual sports, I think is
a different. But for team sports. If you're a college football team and

(18:12):
hunter you played at Notre Dame,of course, a big, big time
program, you might have half adozen NFL caliber players, probably less less
than half a dozen NFL yeah,Whereas you're playing the worst NFL team in
the NFL. Everybody the worst teamin the NFL. All starting guys are

(18:34):
the best players on your college team. Absolutely, absolutely, so I'm trying
to you know, we're just thestupid things that say, oh, I
bet they can beat the Detroit Pistons. No they can't. I will say
this though. When they were showingthe lineups before the game started, I
mean you have actually started lineup,it looked like they could probably all play
football. I mean they were allover. Their number thirteen was a tight

(18:56):
end. Yeah, I mean theythey were horses. And they was showing
the heights and the weights of allthe duke guys and guys under two hundred
pounds one eighty five and the otherguards like you know two o five.
I mean, it was, itwas. It was impressive. It was
a lot of fun. All right, quick little break, coming right back,
taking your calls two one, four, seven, eight seven, nineteen
seventy one or text. By theway, we're always looking for the farthest

(19:19):
away listener, and you could belistening on iHeartRadio app as well and listen
to it from Honolulu. All right, coming right back when we ain't going
to Welcome back six, Welcome backto Inside sports medicine. I think he

(20:00):
was on drugs. The songs it'svery high energy performance. Just because it's
high energy, that doesn't mean you'reon drugs heavy Like the cover looks like
he's on something. Yeah, ifyou could see the cover of the song,

(20:22):
I like, I can't remember hisname is twisted sister? Is the
name of the band? And whatis the name of the guy? I
don't remember, I do, Idon't either. Do anybody have the extra
coffee? Yeah? Thank you?You know where on the air, right?
Okay? Do you have a preferenceon coffee, Scott, Is there
like one particular the coffee rabbit hole? Yes? Now the show is going

(20:48):
to change the direction, so itmakes you tell him about monkey Poopskay,
he's talking about I know what he'stalking about. So the rare, so
I've tried it. It's not thatgreat rare. There a company coffee in
the world copied walk. Uh,it's not monkey. It's actually a marsupial
from Indonesia. It's the fact thatyou know that it deserves a flag.

(21:08):
Okay, but anyway, it's acivet. It's a civet, right,
the marsupial. Yeah, what aboutyou saying, that's the name of the
animal. It's a civet. Whatdoes it look like? It doesn't matter,
A large, round, big ferret. Yeah. So the animal eats
the beans and then poops them,and then you drink them. Well,
then you clean them. Yeah,and then you clean then you clean them,

(21:30):
and then and then grind it.Well, they don't. They don't
eat the beans. They eat thecherries from the coffee, which yeah,
and then it's something about the Itferments in a very pleasurable way. The
things you guys learn on inside sportsmedicine. They you know, it's just
such a valuation. May I answerhis question? Yeah? What? What?

(21:52):
What was the question? The questionis is there specifics to the type
of coffee that I like? Sure? And the answer is yes. And
it has to be no additives,no sweetners or or milk. It's can't
it can't. It's got to becoffee coffee. We can go make them
coffee. We have a coffee machinehere. What is your preferred coffee in

(22:15):
Dallas? I feel like this isa oh no, so, guys is
so te O and I share alove for Hawaiian coffee. ConA coffee and
you can order that online. It'sit's a bit expensive since I don't forard
it all the time, but it'sa treat every once in a while to
do it. And you'd like togrind it fresh at home, put it

(22:37):
in a drip coffee maker. NothingFrench press or special like that, just
good drip coffee bits the beans,it's the ingredients. You gotta have fresh
beans, you grind them up.So Dallas coffee it kind of anything but
Starbucks. So my favorite roaster,So my favorite coffee in Dallas is Merit.
It's actually a roaster out of SanAnto. But there's one right by

(23:00):
my house. It's awesome. Ishould try it, yes, Okay,
it's really good, all right,yeah, because I've seen him around town
and there's one, really but Ialso ship beans in from Houston to have
you ever been to Catalina in Houston? And doctor Ballard's a Houston native,
so yeah. So so do yougrind them at home? Yeah? I
do. Do you have a bladegrinder or a burger grinder? We probably

(23:22):
shouldn't go down. My goodness,I've gone. I've gone to the bottom.
I've gone to the bottom of theinternet on coffee grinders. I've got
a question. When you guys aredone, just let me know. At
what point does somebody say, it'sjust coffee, No, we're gonna take
this poop. Let me just thinkabout it at some point, I mean,

(23:44):
did somebody say, but look,I think if we take this poop,
I think we got something here.I think we got something. I
think think special. Why not understandwe figured that out? Underestimate how hungry
humans have gotten like in the past, right, I mean, just look
across the world at things like weeat what was the first person to eat

(24:08):
oysters? I'm gonna crack this thingopen fresh on the beach and like,
eat this Slug's funny. It's funnythat you say that, because I was
going to use the example of ascallop, like, who's the first person
who would eat a scallop? Theykind of looked weird, but you taste
them, that's like, ooh,this tastes good. I mean, if
you like scalps, like the firsttime I eat ants in Mexico. No

(24:30):
penalty on that one. No,it's it's amazing. That's a bridge too
far. I'm pretty sure that we'velost pretty much everyone listening to the show
right now. They have now tunedinto something else. Do you think that
anybody if our listeners has tried copyLook coffee. I'm gonna go. I'm
gonna guess the over under is zero. Yeah, zero. I've tried it.

(24:52):
Have you got it? I've triedit, yeah, and I didn't
think it was that good. There'salso a lot of discussion of whether it's
ethically sourced. A lot of thea lot of it comes from these farms
where these animals aren't kepting it,you know, solid conditions, and getting
actual natural cope Logwalk coffee is apparentlyreally difficult. So I tried. I
tried. You want the natural?You want the natural? I've tried it

(25:14):
was underwhelmed me too, but Iwould try it again if given the opportunity
I knew it was ethically sourced.Garrett, Please, is there any way
to edit this out? Edit?Edit this out, and and don't ever
replay this section. Sorry, Idid not know I was opening that that
uh doors box with doctor. I'mthinking though that you know, we should
approach Merit Coffee for sponsorship. Theircoffee is awesome. There we go,

(25:38):
We're talking about them without yeah,prompting, without them paying for it exactly
yeah, all right, okay,shared out that I was asking for some
coffee. Yeah, but mine hassugar in it. So here you may
not want to go. This isI think this is a Maya roasting out
of Houston if my memory surfing.So this is inside sports medicine, believe

(26:00):
it or not. So we arethen to shift gears and actually talk about
something sports medicine related. And wetaste coffee now, and we taste coffee.
Yeah. So yeah, very talentedgroup here. Jaden Daniels projected to
be top pick, top three pick, top three pick, top three,

(26:22):
top top three one Heisman. Sowho picks after Chicago that needs a quarterback?
The Patriots and the Commanders. TheCommanders traded away their quarterback they drafted
in the first round a couple ofyears ago, Sam Howell. They traded
him to the Seahawks, and thenthe Patriots. I think, so they
need somebody new. Yeah. Sothe so he's quarterback for LSU. His

(26:48):
numbers are phenomenal. He passed forso many yards and he rushed for so
many yards. The knock on himis that he's too skinny. Yeah,
and and last time, you know, somebody was drafted who was too skinny.
They didn't make it two years becausethe NFL beating. But anyway,
what is going around is a photoof him on his pro day of a

(27:15):
photo of his elbow. If youhaven't seen it, he's got this big
looks like a golf ball on thetip of his elbow. In our world,
it's called electron number sitis. Butit's it's kind of hideous appearing.
And when Hunter, our social mediaguru, showed it to me, the

(27:36):
first thing came to mind is,I've never seen anything look like that.
That's got to be fake, andit may very well have been fake.
But then this brings up the sportsmedicine angle electron number sitis. Dirk had
it, Charles Barkley had it.In fact, I saw Barkley as a

(27:56):
second opinion for his electron number sitis. It's relatively common problem. Anywhere in
your body where you have a bonyprominence, our body grows this little cushion
called a bursa b u rsa,and if it's inflamed, it's called bresidas.
So people have bresidas in their hip, people have breside us in their

(28:18):
elbows and their shoulders. And Idon't know why it's connected with being old.
You know, Oh you're old,you must have bresidas. I don't
know where that came from, butthis is a young man who's what probably
twenty if he's lucky, he's probablytwenty one twenty two. So he's got
bresidas. It's not an old personthing. It can happen to anybody.

(28:42):
Well, if you traumatize the tipof your elbow in basketball, you've you're
taking a charge and you fall backand you hit your elbow on the floor
and it swells up like a golfball, And not only is it kind
of ugly looking, but it's it'snot all that dangerous of a phenomenon,

(29:03):
and it doesn't keep you from playing, and it doesn't hurt, and it's
not really typically very painful. It'sjust kind of ugly looking. And what
I was thinking to myself, ifthat photo is actually real and he's having
pro day, and he's having onehundred and fifty cameraman taking pictures of him,
why would they not put a sleeveover it, Why would they not

(29:26):
drain it, why would why wouldthis actually get out? Sure? I
believe this picture is actually from agame. Oh it wasn't it from pro
Day. Correct. Oh, wellthat's probably been treated all right. In
that case, flag on me becauseI didn't have all the data. Yeah,
well, I mean, yeah,but that's simple. And I try
my best not to drain those things. No, man, if you take

(29:48):
it comes back, right, SoI gets affect him back, but like
it gets infected. We've we've hada case where it was just so here's
the story. So when we wereresidents, I was doing my sports medicine
rotation with one of our mentors,uh Pat Evans huh. And he used
to bring us to during the weekto Cowboys training camp just because he'd have
to check on him and some lesserknown call by quarterback at the time,

(30:14):
Gary Hogebum. Yeah. He hada elecron number SIS and you know,
I'm like a PG two, PGthree, PG four and Pat goes,
yeah, Scott go drain that andhe had me drained. Hoko boom zobo.
So did not get infected. Bythe way, if electric, if
you have elecro number sitis and itis not infected, do whatever you can

(30:37):
to not let somebody put a needlein. Yeah. I always I teach
the in terms of the students resistthe temptation of putting a needle in it
because it is right there. It'slike a balloon. It's a balloon looks
so it looks so satisfying to do. But do your best. Well,
there's two problems. Number one,if you make it infected, you're going
to regret it for like the nextsix months. Number two is if that

(31:02):
hole that you had aspirated it out, of which you typically have to use
a little bit larger diameter needle becausethere's other stuff inside the bursa. There's
little pieces of tissue, you know, just yeah, thicker fluid, so
you have to use a relatively largegauge needle. If that hole doesn't seal,
which sometimes it won't, then itwill drain forever. And yeah,

(31:26):
it goes from an annoying, somewhatunsightly problem to like a really annoying,
potentially like you know, chronic issue. So if you're a primary care physician,
pa m A listening to this showand you see electron beresidis, because
I guarantee you you will, it'svery common. Resist the temptation to put

(31:47):
a needle in it, because ifit does get infected, ninety nine times
out of one hundred it's surgical andthen a lot of a lot of times
electron bersidis. You'll have the bursidisitself and then you'll have an over relying
superficial skin infection called a cellulitis.So then if you go through that skin
infection into the bursa, you've potentiallynow contaminated the bursa. And so even

(32:13):
if you think, oh, thisis infected bursidas, not always and sticking
a need lin it can definitely makeit work. So if you are one
of your people have elecron number sitis, it's a golf ball looking thing on
the tip of your elbow. It'sjust unsightly. How do you treat it?

(32:35):
We've just told everybody not sticking thelinen. How do you treat it?
So number one is patience. Thatnumber one is patients counseling, getting
everybody on. This is assuming thisis non infected electro numbers. If it's
infected, then that's a long discussionthat's different. So non infect electric number
situs is number one. Patients tostop doing whatever you did that caused it.
So if you lean on your elbowwhile you take calls for work,

(32:59):
if you know you can avoid fallingon it again. That's number two.
Number three, Uh, persistent compression, So persistent compressive sleeve potentially also with
a pad to prevent further trauma,sleeve ice, anti inflammatories perhaps and one
of the things that does make iteven more difficult to treat in some people.

(33:21):
It's it's irritated and red and itlooks infected even though it's not.
And so anyway, all right,we've got to go on break. So
apparently we've got we've got a questionprimarily for doctor Blaylock, and we've got
some coffee talk interest and no,Prosper is not that far away. No,

(33:45):
sorry, Prosper is not that faraway. This is Inside Sports Medicine,
TiO Sorrel in the Gang, comingright back. It's in the Vegas.
Was the Fever of sixteen from theschool? John? That's your favorite

(34:07):
song? Story l top ten.I want him to play that at my
funeral, Flora sixty men. Everytime I hear the song, no matter
how many times I've heard it,put a smile on my face. Can
you play this daring surgery? Absolutely? Yeah, welcome back to Inside Sports
Medicine too. Sorry, all inthe Gang, Doctor Ballard, Doctor Blumenthal,

(34:30):
Doctor Blaylock, the three Bes,Hunter and Daniel, and on the
other side of the glass, Garretttaking your calls or questions. We have
a text question I'm going to circleback to. But before last segment,
we were talking about electron on versiitisand how to treat it, et cetera,

(34:52):
et cetera. But it also broughtup a topic that I wanted to
discuss on the air, Doctor Ballard's. He's such a huge asset to Texas
sports medicine. He is so sotalented. I have been diagnosed with Bresidas

(35:14):
of my hip for a decade.Bothers me when I sleep at night,
I can't roll over on it,etc. Etc. And I, you
know, finally ten years ago hesays, go pop in the scanner.
I pop an MRI scanner. It'snot really bersidas, it's the layer under
it. So I had a tendonosisof one of my tendons as it inserted

(35:36):
on an outside part of your hip. And that's a whole different animal,
a whole different diagnosis. And whatdoctor Ballard does with his incredible ultrasound technique,
he can pinpoint exactly like to themillimeter where you put that PRP,
which is now the way to treatthis sort of thing. What fifteen years

(35:59):
ago we didn't really have PRP,play let rich plasma. Now we have
something that's not a courtizone shot.It actually has the potential to heal the
problem. But you're wasting fifteen hundredbucks if it's put in the wrong place.
So you go to Brad Ballard andhe can pinpoint. He helps me
when I do PRP, I say, hey, look, Brad, you

(36:20):
find it for me and I'll stickthe needle in there. Tell people about
how you got interested in this andwhat ultrasound is all about. Yeah.
Yeah, Well, first of all, let me say, docs got burs
sidis, but it's not because ofold age. So I'm just I've had
it for a long time, andI think I'm sorry I need to do
this because I've had a lot ofcoffee. I think all of those people

(36:43):
that we've said you've got hip pricidis, we were wrong. Yeah, well,
we don't really have hippricidis. Well, when you really start to look
at it, either under ultra soundor under MRI, a lot of these
people have partial tears, yes,of a tendon that inserts right on the
side of the hip, and foryears we call it, Oh, you're
just old, you got bersidas.Yeah no, you don't. Yeah yeah

(37:04):
so yeah. So, I meanwhen we look at these tendons that insert
on different areas they shoulder, hip, elbow, knee. The challenge that
we've talked about this before here onair is that these tendons just don't get
the best blood supply. So youneed blood to get to an area to
try to help heal tissue. Andwhen these when these tendons get these small

(37:28):
little micro tears from just getting loadedall the time, either doing a bunch
of pushups or jumping a whole lotor whatever the joint is that's undergoing all
of this tension, these small microtears don't get the best blood supply,
so they just heal funky. Soit's like wear and tear on a tendon,
right, so you end up havingthis chronic pain that lasts a whole

(37:49):
you know, lasts a long time. And so the idea behind PRP is,
can we take the products from theblood that we know help to heal
tissue, and can we put itvery focused in the area to try and
help promote some healing. And that'sexactly what we do, and we can
see that under ultrasound. I kindof nerd out about it. I mean,
the guys who are hearing the clinic, they see me, get the
ultrasound, grab it, show them, see what it looks like under ultraside,

(38:14):
and we can get very, veryvery focused in terms of where we
place it, how you place it. And it does extraordinary. I mean,
we've had patients with that hip problem, knee, elbow, shoulder that
we've been able to get back.And the reason why I got interested in
it is because as a non surgicalsports medicine physician, we need tools in
our toolkit to be able to keeppeople actually on the court and not undergo

(38:37):
surgery. And so it's not foreverybody, but for the right thing,
I think it does extraordinary and alwaysa little caveat. You're not going to
get your PRP injection today and gocompete tomorrow. It's not how it works.
You've got to give it time toactually heal. Yeah. Yeah,
So when we look at the physiologyof healing whenever you do something like that

(39:00):
to attend and it takes on anaverage somewhere between eight and ten weeks for
the tendon to remodel, and we'vegot before and after MRIs. You know
doctor Klaimers, you know, doneMRIs before and after He's like, what
happened to the y? Where isit? Where is it? Like,
well, I mean it's it's healed. So so we've seen him before and
after for stuff like this. Butit does take some time, but it

(39:22):
takes less time than if it waseither operated on or you know, done
some other procedure that's going to bemore invasive. So back in the day,
we used to do surgery on Patellertendinosis. So it's it's Pateller tendonitis,
but it's degenerative and it's basically whatwe're talking about with this Hippocidis story

(39:45):
that I just described. But Pateellertendinosis, Uh, you see it in
a lot of runners and jumpers,and and there's just really not a good
answer. So back in the oldendays, we used to do it at
Pteller tendon de breatment where you goin and you take out the scar tissue
and you sew it together, andthe recovery was three to four months and
it was not necessarily you know,always predictable because scar tissue forms and you

(40:12):
get I used to tell my patientsseventy chance, we're going to get this
right, and you're trying to avoidthat. By the way you are,
you're definitely trying to avoid that.But that was the treatment. In fact,
I did this. You know,we were talking before the game or
before the show. Today we're talkingabout Jimmy Jackson. I did that surgery
on Jimmy Jackson. He played forPortland. He had chronic knee issues.

(40:35):
He flew to Dallas. I said, yeah, we need to debred it.
I didn't have PRP. I havenot done a pateeler a tendon to
breedment since then. Since then becauseplay let rich plasma works. The key
is you got to get it inthe right spot. Spot. You got
to get it in the right spot. And I about six weeks ago,

(40:57):
we did it on a a physician, a doctor who is a big time
runner. And I just saw himThursday and I said, look, if
you're not dramatically better, then eitherI didn't get in the right place or
I missed the spot. Yeah,and sometimes you got to do PRP twice
or three times. Yeah, Scott, do you do PRPs in the back

(41:20):
at all? Not really the researchfor spinal issues, like putting it in
the disc to regenerate the disc.Yeah, set joints, things like that.
It's not really compelling, so Iusually no, no, no,
there are people in town that doit to me without real good evidence to

(41:44):
me. Play let rich plasma worksbest in an area that has a poor
blood supply. So the tendinosis isclassic, whether it's rotator cuff for elbow,
Scott, Scott, you had Scott, you had it in your elbow,
right, Yeah, I had workedMeticonlis met her a lot. I
can't remember, I remember. Butbut there's a blood supply for I mean,

(42:06):
obviously you've got to get the killing. You got to get a blood
supply in addition to the selling antiinflammatory chemicals that PRP has, you should
bring that up. Can be completelya vascular no no no, no,
no, no no no no,it is relatively a vascular. However,
one of the beauties and but Lard'sreally good at this. He's brutal.
You have to kind of pepper thearea. So what you're doing, yeah,

(42:31):
no, you're creating little channels,right, So you're I don't know
what gauge needle you use. Iuse an eighteen, which is a big
gage needle. You're you're creating channelsfor blood supply to come in after the
PRP is done. Yeah. Andif if you've got a part of the
body that that that can't happen likea disc, right, it just doesn't

(42:52):
work. You're saying in tissue thatalready is starting off, that does not
you know, have you know,have a certain level of vascularity. What
Doc is talking about is when weput it in soft tissue, you can
create a healing cascade that starts justjust by needling the tissue. Yeah.
So, yeah, so we don'tdeal with too much soft tissue in That's

(43:14):
right. But Scott, correct meif I'm wrong. But isn't there ast
isn't there a cost to putting aneedle into a disc like that? I
remember, I remember reading, Iremember being taught in residency, and again,
correct me if I'm wrong. I'mnot a spine surgeon that just the
simple introduction of a needle into ahealthy or you know, not completely degenerated

(43:36):
into for deepril disc can cause problems. It's wow, that is funny.
You should say that because up untilthis year twenty three, twenty four,
that was the teaching. It's abored question because there was a study done
at Stanford saying that it accelerated thedegeneration of a normal or near normal disc,

(44:00):
which is exactly what you said.We repeated that research at TBI and
it turns out that that's not true. If you do you know, like
when we do a discogram, heput a very small needle into a disc
and you look ten years later theold research said, oh yeah, you
know, you've got a bigger chanceof problems with that then if you didn't

(44:22):
introduce the needle. Well, wejust finished the study that refutes that landmark
study. We have changed a boardquestion at TBI. That congratulations. So
when I took my board, ithas been published yet. This this has
just been accepted at peer review meetings, so it will be published, but
it will it will change that question. But when I took my boards,
that was the right answer right atthat time, that was at that was

(44:46):
the correct answer. But this isa landmark study. That's that's that is
going to be coming out in thenext year or so. So this is
yet done me a copy yet unpublished, yet unpublished, but verbal communication with
the author, right, all right, Inside Sports Medicine. Come in right
back, uh two one four,seven eight seven, nineteen seventy one,

(45:06):
and I will bring up that question. Actually it's primarily for doctor Blaylock coming
back after this break. You're listeningto Inside Sports Medicine with Doctor t O.
Sorry Howe on ninety seven one thefreak, She answers his father,
please suck Southern beautiful a sun down, beautiful man shots, beautiful son.

(45:43):
Welcome back, Welcome back to InsideSports Medicine. Last segment. This is
your chance to call in or textin questions. By the way, five
five one seven, Thank you somuch for the compo best Saturday morning show
around. Were the specifically referring tothe coffee segment. You know what somebody

(46:08):
else uh six nine two two saidI love the coffee talk. Yeah,
oh I could talk for coffee forhours. There you me too. There
you have it. Shout out toprosper my hometown. Yep, yep,
yep, yep. All right.So, speaking of so one of the
texts that we received earlier that Ithought would be appropriate, and I'm guessing

(46:29):
that Jenny was not comfortable being onthe air, but she did sign the
text. Uh fifty eight years oldrecently diagnosed with carpal tunnel syndrome, and
her question to doctor Blaylock was doesthis always mean surgery? The summary answer
to that is no. So,first off, what is carpal tunnel?

(46:50):
So carpal tunnel? Every time somebodycomes into a hand surgeon's officer, like,
doc, I think it is carpaltunnel. I mean everything from your
you know, fingernail, from anailed to like my wrist is broken,
is somehow or another. It seemslike carple tow all right, wait wait
wait, wait, okay, sinceyou went there, funny, I have
that. Well, Brad, we'vetalked about this before. Shin splints,
anything that happens below the knee andabove the ankle is called shin splints.

(47:15):
Yeah, no matter what the diagnosisis, what I really think it's because
it's one of the few really handsurgery diagnoses that you know, the public
is aware of. And I meanthat's great that they have an interest in,
you know, care of their hands, that kind of thing. But
it it is. Everything that iscalled carpal tunnel is not carpal tunnel.
So what is carpal tunnel? Itis a compression of the median nerve,

(47:37):
which is a nerve in your handthat gives you the ability to feel and
primarily your thumb, index and longfinger actually part of your ring finger as
well, and that nerve gets squishedas it enters the hand going through the
carpal tunnel. The carpal tunnel isa tight area in your wrist that is

(48:00):
combine that is composed of the boneson the top of the wrist in a
thick ligament called the transverse carpal ligamentkind of on the palm. And with
time, as we get older,this tunnel gets squished. And the analogy
I use for patients, particularly anybodyin the trades or anybody who you know
has run a wire in their houseis it's like having a conduit that is

(48:22):
too small for the wire you're tryingto pass and if you pull it through
there, it'll wear off the insulationand you start getting a short. So
I've never done that. That whatwhat kind of analogy is that? I
mean, I'm telling you a lota conduit. Yeah, that's an electrician
analogy. Yeah, okay, Iwas doing this yesterday in my house.

(48:43):
That's why you today, Well,I was running a conduit in my house
for a new plug. You doing, no, I probably you could probably
do it on the kitchen table ifyou had to, but I would I'm
not saying I would do that,or nor would I tell nor what I
would. Don't wait. By theway, before I forget, I need
to talk to Simon because we needto start doing that kind of procedure in
the office on the kitchen tape thatis, that is, actually you need

(49:07):
to get a kitchen table for youroffice. Well, carporle tunnel in the
office isasonable, No, it isnot unreasonable. It's very The procedure was
developed that well, that theory ofdoing the procedure was developed in Canada.
Anyway, I derailed you. Iam so sorry you were anyway about the
conduit. So it's like a wirethat has its insulation worn off of it

(49:28):
and you start getting a short themedian nerves. The symptoms of a short
in your median nerve are numbness andtingling, like I said, primarily the
thumb index and long fingers. Andas carpal tunnel progresses, you can actually
get motor deficits in your hand.Primarily in the hand. The median nerve
innervates a muscle at the base ofyour thumb called abductor Paulsi's brevis, and

(49:51):
you will lose dexterity in your hand. People who have severe carpal tunnel complained
of difficulty with buttons. Ladies willcomplain of difficulty with buttoning their bra putting
in earrings. You'll notice handwriting changesas carpal tunnel becomes more significant. And
if you're to the point of havingthat bad of carpal tunnel, surgery is
typically the answer. But carpal tunnelcan range from you know, my hand

(50:14):
goes numb once or twice a weekwhen I wake up, to you know,
severe motor difficulties with your hand,and based on how bad it is
can based on your treatment option.So the simplest thing to do if you
have mild carpal tunnel, i e. You know you're waking up with a
numb hand, you know once ortwice a week, is to wear a
carpal tunnel brace at night. Theseare available over the counter on Amazon fairly

(50:38):
cheap and it helps. I personallyhave mild carpal tunnel syndrome in both of
my hands, and my treatment isnothing more than I wear braces on my
hands at night. My wife lovesto make fun of me. She calls
it my snooze gear, but hey, it is what it is things that
make carpal tunnel worse. If it'smild, you know that you can augment

(50:59):
on a day to day basis.Weight loss is associated with a decrease in
symptoms of carpal tunnel. Basically,if you have less fat in your body,
there's less fat in the carpal tunnel. There's more room for the nerve.
Seeing your primary care physician to lookinto things. Thyroid disorders can be
associated with carpal tunnel. And thenyou know, things as simple as diet.
If you eat a lot of salt, you know, you go to

(51:20):
Mecosina and have three margaritas and ayou know, a bowl of chips and
get a bunch of salt. Thatretained water that that causes can increase the
symptom. So no, it doesnot always require surgery, but sometimes it
does, and sometimes it's syndicated.All right, So I have a comment
in a question. So I usea lot of electro diagnostics for cervical for
tescheners in the neck, and Icannot tell you how often incidental mild carpal

(51:45):
tunnel syndrome seene electrophysiologically with absolutely nosymptoms, and now the patients have it
in their head, I've got carpaltunnel, and it's like, no,
you don't have carpal tunnel. Yourtest showed a little bit of slow conduction
across the you know, transverse ligamanblah blah blah, but clinically you don't
have it. That's something I seein my practice. My question is do

(52:07):
you do or is there an advantageto this endoscopic carpal tunnel release treatment or
are we still doing just small incisionslike we did when we were residents with
Pete Carter was his joke was howlong does it take you to a carpal
tunnel? He goes eleven minutes thirteenif I teach. So the answer is

(52:30):
unless there's a new paper that I'mnot aware of, the data shows that
the results from indoscopic and open carpaltunnel release are equivalent when you're healed.
So you know what about if Iremember correctly, it's at about three to
six months the results are equivalent openversus endoscopic. So surgery just by the
just for the lay people. Sowhen we do carpal tunnel surgery, you're

(52:54):
basically given the nerve more room.You're putting in a bigger conduit in their
hands. Yeah, you're going inand you're releasing the tight tissue. So
now the nerve has more room.Whether you release that through an incision or
whether you release that through a scope. That's what we're talking. What about
short term? So you said threeto six months, identical, what about

(53:15):
short term? So short term,so to do a carpal tunnel release,
you are cutting the transverse carpal ligamentand giving more space in the carpal tunnel
in the short term. There they'veshown that there is a decreased pillar pain.
So you think about it. Ifyou're putting your hand flat like doing
a push up. The pillar ofyour hand is the palm, like the
base of the thumb over toward thepinky, and there's improved pillar pain early

(53:38):
on, and the incision is ina slightly more advantageous area. It's not
like where you would it's not onthe palm of your hand, it's more
up toward the wrist. When youdo it endoscopically, Now, there are
some downsides to endoscopic it is operatordependent. You don't want somebody who's never
done that before doing it. Youneed to go somebody who does a lot

(53:59):
of them. The other thing,sometimes when you introduce the scope into the
carpoal tunnel, that takes up space. So not only do you have a
tight spot for the nerve to gothrough, now you're shoving a you know,
a camera seven millimeter camera in there. It's probably actually a little more
than that. I haven't measured thenew one recently. You're shoving that in

(54:20):
there. You can squeeze the nervefurther, and you know, I've had
long conversation with this with multiple handsurgeons. There is a very small percentage
of people that when you do that, that compression of the nerve during the
procedure, even though you're releasing thecarpal tunnel afterwards, can cause some problems
in recovery. It's a barrow trauma, a pressure trauma to the nerve that

(54:40):
can occur within do scopic. Now, practitioners been toocopic carpal tunnel are probably
going to be at my throat forsaying that, But I do think it
is a possible complication. Doesn't meanit's wrong to do it into scopically,
particularly if it's done well in thehands of a skin to be done in
the office. Can it be doneon the kitchen TABLETP? No, you
can, I mean, come,let's just get can this that can be

(55:01):
done on you if you had appropriateif you had appropriate sterile technique in a
procedure room, you can do acarpal tunnel with you wide awake, no
anesthesia necessary. Whoa WHOA what?Yeah? Or no? No? No?
No general? Well no general,okay, you need to use local
for sure with epinephrine. It isnot easy to do an endoscopic carpal tunnel

(55:23):
wide awake, I e. Nogeneral anesthesia. I mean, isn't the
patient like wiggling around? And ifyou do it with endoscopic, if you
put an endoscopic camera in somebody's carpaltunnel, who has carpal tunnel in their
way, they're not they can't theycan't sit still. So if you're going
to do it indoscopically, I woulduse some type of sedation or general.

(55:44):
Honestly, even with sedation they'll they'llpull away from you. But if you're
doing it open and you're not puttingthe scope in the carpal tunnel. You
can do that under local a lightacane with epinephrine, and people tolerate it
really well. All right, SoI'm your patient. I need carpal tunnel
release. I want to get backto work as quickly as possible. Are
you going to do it open orendoscopic? After in some in you Scott

(56:07):
the risk of damaging your nerve.I do mostly open carpal tunnel release.
In my hands, I think Ican deliver a safer, better result for
my patients if I do it open. And if you ask me to do
your carpal tunnel I'd be like Scott, I typically do it open. Do
what I tell patients is let thesurgeon do it the way they're comfortable.

(56:30):
And if they go from there,how long before he's back doing surgery?
Uh, stitches are out, woundshealed? Two and a half weeks?
Maybe? Yeah? All right.People who do it endoscopically would sell you
that they could do it sooner,But in my hands, I would tell
you take two and a half weeksoff till your stitches are out and your
hands healed, and go back forit. Make sure if you're going to

(56:52):
have to do a lot of manuallike really like putting in a ton of
pedical screws something like that. Maybehave another set of hands for just like
the hard manual labor. All right, So TEO had me wait for this
question for you from a show thatyou weren't here. Yes, sir,
it's a hand question. And asyou know, my pet peeves are misleading

(57:12):
commercials. And there's a commercial outthat's sponsored by obviously a company for non
surgical treatment of dupatrens contracture. Andthey show a picture of somebody who's got
like a forty five degree dupatrence contractorthat as far as I know, I
don't know any non surgical treatment thatcan make that better. To me,

(57:34):
that's a surgical dupatrence. I findthat commercial very misleading unless you're telling me
that this is some real deal thatyou can rub on your palm and melt
away a forty five degree fixed dupatrins. By the way, real quick,
we got a couple of questions onthe text message once you answer that,
so we got to go rapid fireanswer questions running out of time. So
forty five, let's say forty fivedegrees at the MCP joint. There is

(57:57):
a treatment out there that is moreof amical surgery, but technically non surgical.
It's called zia flex. It's actuallya collagenase. So that's what I
thought. Yeah, you you injectthe collagenase into the Dupatrn's cord. You
have the patient see you back withintwenty four to seventy two hours after it's
had time to work, you know, effectively dissolving the the dupatrans collagen.

(58:21):
You numb them up, you doa manipulation in the office, and you
can you can treat that contractor fortyfive. Now we'd have to talk about
which specific finger, all the risks, you know, there's a lot to
that question. But yes, thereis something that doesn't involve taking a knife
to do patrens. That is anacceptable treatment that I have done and what
it does, It does work evenif it's that bad. Oh, you
can do worse than that. Haveyou seen the commercial I'm talking about?

(58:44):
You know what that? You knowwhat else? They use that for Scott's
disease. I figured you'd look justlook it up. Now, looked it
up. We're not gonna just lookat do not? Can you what does
that say? It says, Okay, I had a risk injury, spraining
a few months ago, and nowI have a small raised not on the

(59:05):
top. Squishun it sounds like it'sa ganglion. It sounds like a ganglion.
Cysts. See, yes, we'rehappy to take a look and conf
Yeah. Usually if it's not botheringyou, I tell people just keep on
where you going. You remember theclassical treatment, which dovetails to the fact
that this is Easter weekend. Hitit with a Bible. Hit the Bible
called a Bible bump, by theway. So obviously that works because it

(59:30):
squishes the ganglion. But doesn't itcome back? I mean ganglions. Ganglions
are all the jury's out on what'sgoing to make them. Like, if
you take a ganglion out surgically,do it well, that has the lowest
rate of recurrence. If you stickan eel in it and drain it,
that tends to come back. Ihad what about the hitting it with a
Bible part. I've only done itonce. It's got to be a Bible.

(59:57):
I did it with a BARLOWI thanyou actually, and it works,
but there's some drinking involved. Yeah. The other question sounds like it says
to how do I avoid getting cisson the top of my wrist. I
don't know how you avoid that.I mean, it's probably a ganglion.
And then again we can ye foranother time discuss ganglion systs. So we're

(01:00:21):
we're wrapping it up. We're takingadvantage of the fact that we have a
bunch of doctors in the room andpotential doctors in the room. And there
are a couple of things that wedo at Texas Sports Medicine and at the
Center for disc Replacement that is wethought was standard operating procedure, but apparently

(01:00:44):
in modern medicine nowadays, communicating withyour patient is not standard operating procedure.
A couple of things came came up. Somebody was talking to me about how
long is my prep for to visitand mine is very long. It's forty
five minutes. Because that's when youmanage patient expectations. That's when you tell

(01:01:07):
them the incision goes here. That'swhen you tell them that you're going to
have numbness around this incision, butnot around that incision. That's when you
tell them that I leave the portalsopen, so if you see blood on
addressing, that's not going to freakyou out. To me. The management
of patient expectations is so important ifyou're going to do procedure work. The

(01:01:29):
other component of communication is after theprocedure is over. I always talk to
my patient and talk to my patientfamilies. Now, if you talk to
the patient and recovery, they maynot remember that, but sometimes I'll circle
most of the time I'll circle backtwice. But the day where you do

(01:01:49):
the procedure and leave, to me, that is just absolutely unacceptable, unacceptable.
So Scott, I know that youdo it the same way I do
because we've been trained by the samepeople. Your preoperative visit, how important
is that? And post operative youtalk to your people. Oh yeah,

(01:02:12):
So you know we always consult withthe family afterwards. And I have the
same issue and we use a littlemore general anesthester than you do. So
I actually see the patient when theyget their auto recovery room into their room,
but if it's in the first houror two, I'm talking to him
and I said, there is inthe family members here, so there's a
reasonably good chance he's not going toremember that I talked to him. I

(01:02:36):
say, the next morning, it'slike, do you remember we talked about
this yesterday? Because I didn't seeyou yesterday. I'd say this same exactly,
but ers a little bit. AndI always when I'm doing the artificial
dissurgery, we take a picture atX ray at the end and I'll make
a like a paper copy, andI actually give it to the patients and
say, here's good. You know, this is what it looked like when

(01:02:59):
we're done, and you can keepthat. And now these days they come
to office, you take an Xray and they just snap a picture with
their phone of the screen because it'sall digital now. But it's a good
way to document what you've done andhave that good conversation. And our preoperative
visits even a little bit different.We have we have three people talking to
them, so I have my PAgo over the list that I'm going to

(01:03:22):
forget of, all the things onthe concent my ame going over the preoperative
scrubbing of the prepping of the site, and then I come in and wrap
it up. So it's about thesame thing. It's about forty five minutes
to an hour, but it's they'rethere for a communication communication communication, managing
patient expectations, explaining to them thatyeah, if you see blood underdressing you're

(01:03:43):
not dying. That's part of thedeal. What's that music? I don't
know. Oh, it just meansit means the time for us to leave.
Oh yeah, that's what it is, all right. So, uh,
we have a lot of texts andI'm so sorry I can't get back
to all of them, but we'lltry to get them next week. They

(01:04:04):
started coming in last minute, Iknow, which is earlier. We'll start
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